Department of Neurosurgery, Lariboisière Hospital, University of Paris, 2 rue Ambroise Paré, 75010, Paris, France.
Acta Neurochir (Wien). 2022 Aug;164(8):2049-2055. doi: 10.1007/s00701-021-04927-8. Epub 2021 Jul 1.
Surgery for deep-seated brain tumors remains challenging. Transcortical approaches often require brain retraction to ensure an adequate surgical corridor, thus possibly leading to brain damage. Various techniques have been developed to minimize brain retraction such as self-retaining retractors, endoscopic approaches, or tubular retractor systems. Even if they evenly distribute the mechanical pressure over the parenchyma, rigid retractors can also cause some degree of brain damage and have significant disadvantages. We propose here a soft cottonoid retractor for microscopic resection of deep-seated and ventricular lesions.
Through a small corticectomy, a channel route with a blunt cannula is developed until the lesion is reached. Then, a "balloon-like system" made with a surgical glove is progressively inflated, dilatating the surgical corridor. A mini-tubular device, handmade by suturing a surgical cottonoid, is positioned into the corridor, unfolded, and sutured to the edge of the dura, to prevent it from being progressively expelled from the working channel. This allows a good visualization of the lesion and surrounding structures under the microscope.
Advantages of this technique are the softness of the tube walls, the absence of rigid arm to hold the tube, and the possibility for the tube to follow the movements of the instruments and to modify its orientation according to the working area.
This simple and inexpensive tubular working channel for microscopic transcortical approach is a valuable alternative technique to traditional self-retaining retractor and rigid tube for the microsurgical resection of deep-seated brain tumors.
深部脑肿瘤的手术仍然具有挑战性。经皮质入路通常需要脑牵拉以确保足够的手术通道，因此可能导致脑损伤。已经开发了各种技术来最小化脑牵拉，例如自固定牵开器、内窥镜入路或管状牵开器系统。即使它们均匀地分布在脑实质上的机械压力，刚性牵开器也可能导致一定程度的脑损伤，并具有显著的缺点。我们在此提出一种用于深部和脑室病变的显微切除的软性棉絮状牵开器。
通过小皮质切除术，用钝套管开发一条通道，直到到达病变部位。然后，用手术手套制成的“气球样系统”逐渐充气，扩大手术通道。手工缝合手术棉絮制成的迷你管状装置被放置在通道中，展开并缝合到硬脑膜边缘，以防止其逐渐从工作通道中排出。这允许在显微镜下很好地观察病变和周围结构。
该技术的优点是管壁柔软、没有刚性臂来固定管、以及管可以跟随器械的运动并根据工作区域改变其方向。
这种用于经皮质显微入路的简单且廉价的管状工作通道是传统自固定牵开器和刚性管的有价值的替代技术，可用于深部脑肿瘤的显微切除。
